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BC Cancer Protocol Summary for Carboplatin and Etoposide in the Treatment of Recurrent Ependymoma and Oligodendroglioma

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BC Cancer Protocol Summary for Carboplatin and Etoposide in the Treatment of Recurrent Ependymoma and Oligodendroglioma BC Cancer Protocol Summary for CARBOplatin and Etoposide in the Treatment of Recurrent Ependymoma and Oligodendroglioma Protocol Code CNCARV Tumour Group Neuro-Oncology Contact Physician Dr. Brian Thiessen ELIGIBILITY • Diagnosed recurrent ependymoma, post-surgery and/or Radiation Therapy. • 2nd line for recurrent oligodendroglioma. • 3rd and 4th line treatment of recurrent high grade gliomas, including oligodendroglioma • Life expectancy greater than 3 months. • Normal renal, hepatic and bone marrow function. TESTS: . Baseline: CBC and differential, platelets, creatinine, ALT, bilirubin, electrolytes, magnesium, calcium . Before each treatment: . Day 1: CBC and differential, platelets, creatinine . Day 14 and 21: CBC and differential . CT/MRI every second to third cycle . If clinically indicated: ALT, Bilirubin PREMEDICATIONS: . Antiemetic protocol for High/Moderate emetogenic chemotherapy . Hydrocortisone & diphenhydrAMINE for history of hypersensitivity to etoposide TREATMENT: Drug Dose BC Cancer Administration Guideline CARBOplatin Dose = AUC* x (GFR+25) IV in 100 to 250 mL NS over 30 min IV in 250 to 1000 mL NS over 45 min to 1 hour 30 min etoposide 100 mg/m2 (use non-DEHP bag and non-DEHP tubing with 0.2 micron in-line filter) *AUC = 5 BC Cancer Protocol Summary CNCARV 1 of 2 Activated: N/A 1 Apr 2017 Revised: 1 June 2021 (Tests revised) Warning: The information contained in these documents are a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use available at www.bccancer.bc.ca/terms-of-use GFR preferably from nuclear renogram, if not possible use: N x (140-age in years) x wt (kg) GFR = N = 1.04 (women) or 1.23 (men) serum creatinine (micromol/L) The estimated GFR calculated using the Cockcroft-Gault equation should be capped at 125 mL/min when it is used to calculate the initial carboplatin dose. When a nuclear renogram is available, this clearance would take precedence. Repeat every 28 days until progression as tolerated DOSE MODIFICATIONS: 1. For Hematology: modify both drugs. ANC (x109/L) Platelets (x109/L) Dose (both drugs) greater than or and greater than or equal to 100 100% equal to1.5 less than 100 delay and greater than or equal to 100 75% 1.0 to less than 1.5 less than 100 delay and greater than or equal to 100 delay less than 1.0 less than 100 delay . For platelets nadir less than 50 x109/L, 25% dose reduction for both drugs. For neutropenic fever, 25% dose reduction for both drugs. 2. For serum creatinine 1.5 times upper limit normal, review program. 3. For symptomatic neuropathy - review program. 4. Hepatic dysfunction: if ALT greater than 5 x ULN or bilirubin greater than 25 micromol/L, hold chemotherapy until liver function returns to normal. PRECAUTIONS: 1. Hypersensitivity: Monitor infusion of etoposide for the first 15 minutes for signs of hypotension. Hypersensitivity reactions have also been reported for CARBOplatin. Refer to BC Cancer Hypersensitivity Guidelines. 2. Extravasation: etoposide causes irritation if extravasated. Refer to BC Cancer Extravasation Guidelines. 3. Neutropenia: Fever or other evidence of infection must be assessed promptly and treated aggressively. 4. Progression - greater than 25% increase in measurable disease or progressive neurological dysfunction. Call Dr. Brian Thiessen or tumour group delegate at (604) 877-6000 or 1-800-663- 3333 with any problems or questions regarding this treatment program. BC Cancer Protocol Summary CNCARV 2 of 2 Activated: N/A 1 Apr 2017 Revised: 1 June 2021 (Tests revised) Warning: The information contained in these documents are a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use available at www.bccancer.bc.ca/terms-of-use .
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